Objective: The association between renin-angiotensin-aldosterone (RAAS) inhibitors and Coronavirus diseases 2019 (COVID-19) mortality is unclear. We aimed to explore the association of RAAS inhibitors, including angiotensin-converting inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality in patients with hypertension. Methods: MEDLINE, SCOPUS, OVID, and Cochrane Library were searched for the period of January 1, 2020 to May 20, 2020. Studies reporting the association of RAAS inhibitors (ACEi and ARBs) and mortality in patients with hypertension, hospitalized for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio estimates, and heterogeneity was quantified. Results: Data were collected on 2,065,805 individuals (mean age, 58.73 years; 53.4% male). Patients with hypertension taking RAAS inhibitors were 35% less likely to die from COVID-19 compared to patients with hypertension not taking RAAS inhibitors (pooled RR= 0.65, 95% Confidence Intervals (CI): 0.45-0.94). To explore the association of COVID-19 and specific classes of RAAS inhibitors, we conducted a subgroup analysis of ARBs and ACEi separately from studies that provided them. Pooled risk ratio estimates from ARBs and ACEi showed a lower but not significant risk of death from COVID-19 (RR=0.93, 95% CI: 0.70-1.22) and ACEi (RR=0.65, 95% CI: 0.32-1.30). Conclusions: In this meta-analysis, it was discovered that taking RAAS inhibitors, significantly decreased the risk of COVID-19 mortality in patients with hypertension. This indicates a potential protective role that RAAS-inhibitors may have in COVID-19 patients with hypertension.

中文翻译：

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肾素-血管紧张素-醛固酮系统抑制剂与住院COVID-19的高血压患者的死亡率：系统评价和荟萃分析

目的：肾素-血管紧张素-醛固酮（RAAS）抑制剂与2019年冠状病毒疾病（COVID-19）死亡率之间的关联尚不清楚。我们旨在探讨RAAS抑制剂（包括血管紧张素转换抑制剂（ACEi）和血管紧张素II受体阻滞剂（ARB））与高血压患者COVID-19死亡率的关系。方法：检索MEDLINE，SCOPUS，OVID和Cochrane库，以查找2020年1月1日至2020年5月20日的时间。研究报告了因COVID-而住院的高血压患者的RAAS抑制剂（ACEi和ARBs）与死亡率之间的关系。提取了19个。两位审稿人独立提取了合适的相关数据并评估了偏见的风险。所有分析均使用对数转换后的风险比估算值的随机效应模型进行，并量化了异质性。结果：收集了2,065,805人的数据（平均年龄58.73岁；男性53.4％）。与未服用RAAS抑制剂的高血压患者相比，服用RAAS抑制剂的高血压患者死于COVID-19的可能性降低了35％（合并RR = 0.65，95％可信区间（CI）：0.45-0.94）。为了探索COVID-19与特定类别的RAAS抑制剂的关系，我们对提供ARB和ACEi的研究分别进行了亚组分析。来自ARB和ACEi的汇总风险比估计值显示出较低但并非显着的死于COVID-19（RR = 0.93，95％CI：0.70-1.22）和ACEi（RR = 0.65，95％CI：0.32-1.30）的死亡风险。结论：在这项荟萃分析中，发现服用RAAS抑制剂可显着降低高血压患者COVID-19死亡的风险。